Starting on July 1st, 2022, based on the CMS Transparency in Coverage Final Rule, the Federal Government requires health insurers and group health plans, including self-funded clients, to publish and update on a monthly basis pricing data in "machine readable formats" for covered items and services based on in-network negotiated payment rates and historical out-of-network allowed amounts. Likely, the total size of the data published by the payers would be close to 1 Petabyte (which is 1,024 TB, or 1,048,576 GB).
We may help you gain actionable insights from this big data on negotiated rates.
As a provider, you may get analytics on demand to:
Find out how your rates compare with those of your competitors.
Identify services with opportunity to optimize the negotiated rate.
Compete on a level field.
Analytics on demand
Example: Aetna Health Inc. (a New Jersey Corporation), Aetna HMO, for MRI UPPER EXTREMITIES, fee for service, negotiated institutional billing, version 1.3.1 shows rates for those providers in the example below between $425 and $1,006 for the place of service 11 (office).
Granular insights on negotiated rates within your state, for various plans
Identify services with negotiated rates that may be optimized.
We'd love to hear from you! Please contact us with any questions or requests. In addition, if you're interested in getting insights about negotiated rates for a specific plan, please fill out the form below.